By Christopher Cheney
In the past decade, the annual rates for in-hospital adverse events decreased for acute myocardial infarction, heart failure, pneumonia, major surgical procedures, and all other conditions, a new research article found.
Patient safety has been a pressing issue in healthcare since 1999, with the publication of the landmark report To Err Is Human: Building a Safer Health System. Despite two decades of attention, estimates of annual patient deaths due to medical errors rose steadily to as many as 440,000 lives, a figure that was reported in the Journal of Patient Safety in 2013.
The new research article, which was published in the Journal of the American Medical Association, is based on data collected from more than 244,000 adult patients hospitalized in 3,256 hospitals from 2010 to 2019. The study used data from the Medicare Patient Safety Monitoring System, which features 21 measures from four kinds of adverse events—adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls).
The study generated several key data points:
- From 2010 to 2019, adverse events for acute myocardial infarction decreased from 218 to 139 per 1,000 hospital discharges
- From 2010 to 2019, adverse events for heart failure decreased from 168 to 116 per 1,000 hospital discharges
- From 2010 to 2019, adverse events for pneumonia decreased from 195 to 119 per 1,000 hospital discharges
- From 2010 to 2019, adverse events for major surgical procedures decreased from 204 to 130 per 1,000 hospital discharges
- From 2012 to 2019, adverse events for all other conditions were unchanged at 70 adverse events per 1,000 hospitals discharges
- After adjustment for patient and hospital characteristics, there was a significant decrease in the relative risk of adverse events for all other conditions from 2012 to 2019
- For acute myocardial infarction, heart failure, pneumonia, and major surgical procedures, overall observed in-hospital mortality declined from 4.6% in 2010 to 2.7% in 2019
- For the all other conditions group, overall observed in-hospital mortality increased from 1.2% in 2012 to 2.2% in 2016, with the rate at 1.7% in 2019
“In the U.S. between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures, and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions,” the study’s co-authors wrote.
Interpreting the data
Although the trends reported in the study do not definitely point to improvement in patient safety, the Medicare Patient Safety Monitoring System was designed to monitor adverse events, the study’s co-authors wrote. Two other factors indicate the trends reflect an improvement in patient safety, they wrote. “The basis for the estimates is a highly structured and reproducible medical record abstraction process conducted at a central location by specialists in this work, and the definitions and measurement protocols were consistent over the study period.”
The positive trends in adverse events are also consistent with major patient safety improvement initiatives launched during the study period such as the Partnership for Patients program as well as programs at the Centers for Medicare & Medicaid Services that target acute myocardial infarction, heart failure, and pneumonia, the study’s co-authors wrote. Other factors could have improved patient safety, they wrote. “New technologies to support safety also were implemented along with new initiatives to increase person and family engagement in safety efforts. … Other factors such as spread of safer processes of care may also have played a role. Advances in care not directly attributable to patient safety efforts also may have contributed to the improvements (e.g., the widespread adoption of minimally invasive surgical techniques).”
The co-authors speculated on the cause of the only increase in adverse event rates reported in the study. “The only increase in adverse event rates was in the general adverse events domain for the all other conditions patient group in 2014 to 2019, and this finding may indicate a special need for new initiatives related to prevention of pressure ulcers and inpatient falls.”
The co-authors also speculated about why there was a relatively low decrease in adverse events for the all other conditions category. “The lower overall rate of decline in adverse event rates in the all other conditions group, compared with the acute myocardial infarction, heart failure, pneumonia, and major surgical procedures groups, might be due to the quality improvement efforts targeted at the latter 4 conditions, whereas similar interventions did not occur for most of the conditions represented in the all other conditions group. Furthermore, the baseline adverse event rates were much lower in the all other conditions group, potentially leaving less opportunity to achieve improvement.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.